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Research

Association between serum cholesterol and eating behaviours during early childhood: a cross-sectional study

Navindra Persaud, Jonathon L. Maguire, Gerald Lebovic, Sarah Carsley, Marina Khovratovich, Janis A. Randall Simpson, Brian W. McCrindle, Patricia C. Parkin and Catherine Birken; for the TARGet Kids! collaboration
CMAJ August 06, 2013 185 (11) E531-E536; DOI: https://doi.org/10.1503/cmaj.121834
Navindra Persaud
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
MD MSc
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  • For correspondence: [email protected]
Jonathon L. Maguire
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
MD MSc
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Gerald Lebovic
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
PhD
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Sarah Carsley
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
MSc
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Marina Khovratovich
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
MD
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Janis A. Randall Simpson
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
PhD
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Brian W. McCrindle
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
MD MPH
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Patricia C. Parkin
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
MD
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Catherine Birken
Keenan Research Centre (Persaud, Lebovic, Maguire), Li Ka Shing Knowledge Institute; the Department of Family and Community Medicine (Persaud), St. Michael’s Hospital and the University of Toronto; the Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT) (Maguire, Parkin, Birken), The Hospital for Sick Children; the Department of Pediatrics (Maguire, McCrindle, Parkin, Birken), the University of Toronto, Toronto, Ont.; Family Relations and Applied Nutrition (Randall Simpson), University of Guelph, Guelph, Ont.; and the Division of Cardiology (McCrindle), The Hospital for Sick Children, Toronto, Ont.
MD MSc
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  • Figure 1:
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    Figure 1:

    Recruitment of participants to the study. *TARGet Kids! is a primary care research network in Toronto, Ontario. The network currently includes 7 large group practices, each of which has between 3 and 10 practising physicians.

Tables

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    Table 1:

    Characteristics of participants and nonparticipants

    CharacteristicNo. (%)*p value
    Participants n = 1076Nonparticipants n = 780
    Age, yr, mean (± SD)4.14 (± 0.84)4.13 (± 0.82)0.7
    Sex, male528 (49.1)393 (50.3)0.6
    BMI z score, mean (± SD)0.35 (± 1.01)0.30 (± 1.07)0.4
    Maternal BMI, mean (± SD)25.2 (± 4.74)24.8 (± 4.45)0.06
    Maternal postsecondary education914 (84.9)650 (83.3)0.6
    Gestational diabetes44 (4.1)26 (3.3)0.6
    Ethnicity with high cardiovascular risk123 (11.4)78 (10.0)0.3
    Ethnicity with high metabolic risk367 (34.1)240 (30.8)0.1
    • Note: BMI = body mass index, SD = standard deviation.

    • ↵* Unless otherwise indicated.

    • View popup
    Table 2:

    NutriSTEP questionnaire responses

    NutriSTEP score or subscoreItem mean scores (± SD)No. of itemsMaximum possible value
    Total15.03 (± 6.60)1768
    Subscore
     Eating behaviours3.81 (± 2.20)520
     Dietary intake7.24 (± 3.39)624
     Parental concern1.41 (± 2.47)416
     Screen time*0.67 (± 0.94)*14
     Supplements†2.02 (± 1.53)*14
    • Note: SD = standard deviation.

    • ↵* Dichotomous (≤ 2 v. > 2 h/d); 149 participants (13.8%) reported more than 2 h/d.

    • ↵† Dichotomous (rarely/never v. sometimes to always; 607 participants (56.4%) reported using supplements sometimes to always.

    • View popup
    Table 3:

    Regression model showing association between serum non-HDL cholesterol level, patient characteristics and nutritional risk subscores

    CharacteristicAdjusted* beta estimate (95% CI)p value
    Age−0.04 (−0.09 to 0.00)0.06
    Sex, Male−0.12 (−0.20 to −0.05)0.001
    Birth weight0.01 (−0.05 to 0.06)0.8
    zBMI0.04 (−0.001 to 0.07)0.06
    Parental BMI−0.01 (−0.02 to −0.002)0.01
    Gestational diabetes0.02 (−0.17 to 0.22)0.8
    Maternal education — postsecondary−0.02 (−0.16 to 0.10)0.7
    Ethnicity, elevated risk†0.07 (−0.06 to 0.20)0.3
    Ethnicity, reduced risk†0.01 (−0.13 to 0.15)0.9
    NutriSTEP subscore
     Eating behaviours0.02 (0.002 to 0.05)0.03
     Dietary intake−0.01 (−0.02 to 0.01)0.3
     Parental concern−0.01 (−0.02 to 0.01)0.3
     Screen time0.09 (−0.04 to 0.21)0.2
     Supplements−0.01 (−0.09 to 0.07)0.9
    • Note: BMI = body mass index, CI = confidence interval, HDL = high-density lipoprotein.

    • ↵* Adjusted for all other variables in the Table.

    • ↵† Children were assigned ethnicity based on the highest-risk ethnicity of their parents (see Appendix 2, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.121834/-/DC1).

    • View popup
    Table 4:

    NutriSTEP subscores and beta estimates for laboratory indices from our regression models

    NutriSTEP subscoreBeta estimates (95% CI)
    Non-HDL cholesterolLDL cholesterolApolipoprotein BHDL cholesterolApolipoprotein A1
    Eating behaviours0.02 (0.002 to 0.05)0.02 (0.002 to 0.05)0.01 (0.002 to 0.01)−0.008 (−0.02 to 0.001)−0.004 (−0.01 to 0.003)
    Dietary intake−0.01 (−0.02 to 0.01)−0.009 (−0.02 to 0.004)−0.001 (−0.004 to 0.002)0.002 (0.004 to 0.008)0.003 (−0.001 to 0.01)
    Parental concern−0.01 (−0.02 to 0.01)−0.004 (−0.02 to 0.01)−0.001 (−0.01 to 0.004)0.004 (−0.004 to 0.012)0.001 (−0.01 to 0.01)
    Screen time0.09 (−0.04 to 0.21)0.07 (−0.05 to 0.19)0.002 (−0.03 to 0.03)0.02 (−0.04 to 0.07)0.01 (−0.04 to 0.05)
    Supplements−0.01 (−0.09 to 0.07)−0.01 (−0.09 to 0.07)−0.01 (−0.03 to 0.01)−0.01 (−0.04 to 0.03)0.02 (−0.02 to 0.05)
    • Note: CI = confidence interval, HDL = high-density lipoprotein, LDL = low-density lipoprotein.

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Canadian Medical Association Journal: 185 (11)
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Vol. 185, Issue 11
6 Aug 2013
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Association between serum cholesterol and eating behaviours during early childhood: a cross-sectional study
Navindra Persaud, Jonathon L. Maguire, Gerald Lebovic, Sarah Carsley, Marina Khovratovich, Janis A. Randall Simpson, Brian W. McCrindle, Patricia C. Parkin, Catherine Birken
CMAJ Aug 2013, 185 (11) E531-E536; DOI: 10.1503/cmaj.121834

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Association between serum cholesterol and eating behaviours during early childhood: a cross-sectional study
Navindra Persaud, Jonathon L. Maguire, Gerald Lebovic, Sarah Carsley, Marina Khovratovich, Janis A. Randall Simpson, Brian W. McCrindle, Patricia C. Parkin, Catherine Birken
CMAJ Aug 2013, 185 (11) E531-E536; DOI: 10.1503/cmaj.121834
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